[Assisted Reproduction and Preimplantation Genetic Diagnosis in Patients Susceptible to Breast Cancer]. / Asistovaná reprodukce a preimplantacní genetická diagnostika u pacientek ohrozených karcinomem prsu.

BACKGROUND: Assisted reproduction, as well as pregnancy itself, in patients with breast cancer or other hereditary type of cancer, is a widely discussed topic. In the past, patients treated for breast cancer were rarely involved in the discussion about reproductive possibilities or infertility treatment. However, current knowledge suggests, that breast cancer is neither a contraindication to pregnancy, nor to assisted reproduction techniques. On the contrary, assisted reproduction and preimplantation genetic diagnosis methods might prevent the transmission of genetic risks to the fetus. AIM: In this review we summarize data concerning pregnancy risks in patients with increased risk of breast cancer. In addition, we introduce current possibilities and approaches to fertility preservation prior to assisted reproduction treatment as well as novel methods improving the safety of fertility treatment. In the second part of this review, we focus on karyomapping--an advanced molecular genetic tool for elimination of germinal mutations in patients with predisposition to cancer. Moreover, the rapid development of preimplantation genetic diagnosis methods contributes to detection of both chromosomal aneuploidy and causal mutations in a relatively short time-span.

[Orbital complications of sinusitis]. / Orbitálne komplikácie zápalov prínosových dutín.

Orbital complications categorised by Chandler are emergency. They need early diagnosis and agresive treatment. Stage and origin of orbital complications are identified by rhinoendoscopy, ophtalmologic examination and CT of orbite and paranasal sinuses. Periorbital cellulitis and early stage of orbital cellulitis can be treated conservatively with i. v. antibiotics. Monitoring of laboratory parameters and ophtalmologic symptoms is mandatory. Lack of improvement or worsening of symptoms within 24-48 hours and advanced stages of orbital complications are indicated for surgery. The purpose of the study is to evaluate epidemiology, clinical features and management of sinogenic orbital complications. Retrospective data of 8 patients with suspicion of orbital complication admited to hospital from 2008 to 2013 were evaluated. Patients were analyzed in terms of gender, age, CT findings, microbiology, clinical features, stage and treatment. Male and female were afected in rate 1,66:1. Most of patients were young adult in 3rd. and 4th. decade of life (62,5 %). Acute and chronic sinusitis were cause of orbital complication in the same rate. The most common origin of orbital complication was ethmoiditis (62,5 %), than maxillary (25 %) and frontal (12,5 %) sinusitis. Polysinusitis with affection of ethmoidal, maxillary and frontal sinuses (75 %) was usual CT finding. Staphylococcus epidermidis and Staphylococcus aureus were etiological agens in half of cases. Periorbital oedema (100 %), proptosis, chemosis (50 %), diplopia and glaucoma (12,5 %) were observed. Based on examinations, diagnosis of periorbital oedema/preseptal cellulitis was made in 3 (37,5 %), orbital cellulitis in 3 (37,5 %) and subperiosteal abscess in 2 cases (25 %). All patients underwent combined therapy - i. v. antibiotics and surgery within 24 hours. Eradication of disease from ostiomeatal complex (OMC), drainage of affected sinuses and drainage of subperiosteal abscess were done via fuctional endonasal endoscopic surgery (FEES). In case of superior subperiosteal abscess, combined endonasal and external approach (external orbitotomy) was needed. Combined therapy facilitated quick improvement of local and systematic symptoms. Average time of hospitalisation was 7 days. Early diagnosis and agresive combined therapy prevent loss of vision and life threatening complications.

Different fusion configurations of evolutionarily conserved segments in karyotypes of Potamochoerus porcus and Phacochoerus africanus.

The karyotype of the red river hog Potamochoerus porcus (2n = 34) differs from that of the domestic pig by the presence of 2 fusion chromosomes homologous to pig chromosomes 13/16 and 15/17. Moreover, chromosomes corresponding to pig chromosomes 13/16 and 1 are both acrocentric. Hybridization with region-specific painting probes confirmed tandem fusion of pig chromosomes 13 and 16, and a pericentric inversion of the pig chromosome 1p equivalent in P. porcus. The chromosome complement of the wart hog Phacochoerus africanus (2n = 34) differs from the pig karyotype in 2 centric fusions, 13/16 and 15/17. Karyotypic relationships among different Suidae species are discussed in the article. Besides fusions 13/16 and 15/17, which are common to several suids, another fusion of pig chromosomes 14 and 18 is suggested to exist in the karyotype of Sus cebifrons.

Investigation of chromosome aneuploidies in early porcine embryos using comparative genomic hybridization.

Although numerical chromosome errors are known to be prevalent in early human embryos and are likely to be a considerable factor influencing the mortality of early embryos and implantation failure, in domestic animals data about the frequency and nature of errors is limited. The objectives of this study were to investigate the whole chromosome set of in vivo obtained early pig embryos, applying methods of whole genome amplification and comparative genomic hybridization (CGH) and to contribute to the comprehensive understanding of the topic. The embryos were collected from gilts 72 h after insemination. Further, they were lysed and underwent whole genome amplification by multiple displacement amplification. In a subsequent CGH, amplified DNA was compared to control DNA using different fluorescent labeling and hybridization to male pig mitoses. 11 (14.3%) of the 77 pig embryos examined were observed to be aneuploid. We found chromosome errors comprising loss/gain of one or a few chromosomes (10.4%) but also extensive chromosome imbalances (3.9%). Chromosomes 8, 11, 12, 13, 17, and X were most frequently involved in aneuploidies, when compared to chromosomes 2, 9, and 18, which were rarely involved in chromosome errors.

[EPI-LASIK--2 years' clinical results]. / EPI-LASIK--2-rocné klinické skúsenosti.

PURPOSE: To evaluate the clinical results of Epi-LASIK, a new surface ablation surgical technique for the treatment of low and middle myopia. METHODS: Twenty eyes of 10 patients had Epi-LASIK for the correction of low and middle myopia. Mean preoperative spherical equivalent of the refractive error was 3.64 diopters (D) +/- 1.9 D, and the best spectacle-corrected visual acuity was from 1.0 to 0.8 in 100 % of eyes. All epithelial separations were performed with the Krumiech-Barraquer microkeratome (Lasitome Gebauer). In the postoperative period the patients filled out a questionnaire grading pain score of the treated eyes. RESULTS: The mean uncorrected visual acuity at 1 month after the operation was from 1.0 to 0.8 in 90 % of eyes. After 12 months, the mean spherical equivalent of the refractive error of the treated eyes was -0.262 +/- 0.15 D (from -0.25 to +0.25 D). One hundred percent of eyes had clear corneas at 6 months after the treatment. After 24 months, the mean spherical equivalent of the refractive error was -0.258 I 0.14 D, no "haze" was observed. CONCLUSIONS: The first clinical results suggest that Epi-LASIK is a safe, less painful and efficient method for the correction of low and middle myopia. We suppose, further studies will establish this method as a very good alternative surface ablation procedure.

Nonseminomatous germ cell testicular tumors clinical stage I: differentiated therapeutic approach in comparison with therapeutic approach using surveillance strategy only.

Surveillance after orchiectomy alone becomes popular for the management of clinical stage I nonseminomatous germ cell testicular tumors (CS I NSGCTT). Effort to identify patients at high risk of relapse leads to searching for risk factors of CS I NSGCTT. The aim of the study was to analyse own long-term experiences with different therapeutic approaches in CS I NSGCTT patients according to risk factors of the disease progression and to correlate these results with the group of patients who were treated with surveillance strategy only. From 11/1984 to 12/1991 a total of 145 patients with CS I NSGCTT were treated with surveillance strategy only (group A) and were followed-up to 1/2007. Patients, who had the disease progression, were treated with systemic chemotherapy. The disease progression was experienced in 52 patients (35.9 %). The overall survival rate of the patients in this group was 130/145 (89.7 %). From 1/1992 to 1/2007 a total of 323 patients with CS I NSGCTT were stratified to different risk-adapted therapeutic approaches (groups B1-3) according to histopathologic findings of primary tumor removed by inguinal orchiectomy. 111 patients (group B1) with vascular invasion and majority of embryonal carcinoma component in the primary tumor were treated with adjuvant chemotherapy (2 cycles of BEP). Disease progression developed in two patients (1.9 %). Other patients live without evidence of disease (NED). None of them died. Among 11 patients (group B2) with vascular invasion and majority with teratomatous elements in the primary tumor underwent primary retroperitoneal lymph node dissection (RPLND), 9 were found to be pathological stage I. The disease progression was observed in two patients (18.2 %), they died 87-122 months following orchiectomy. Two patients (18.2 %) with pathological stage II received adjuvant chemotherapy. Other 7 patients live with NED following RPLND. 201 patients (group B3) without vascular invasion have been followed after orchiectomy alone. They were kept under close surveillance, consisting of regular follow-up with tumor markers, chest x-ray and CT of the retroperitoneum. The disease progression was observed in 39 patients (19.4 %), who were treated with BEP chemotherapy. Three of them (7.7 %) died after a mean follow-up of 32.7 months following orchiectomy. The overall survival rate of all patients in group B1-3 was 98.4 %. Introduction of different therapeutic approaches in CS I NSGCTT patients according to risk factors of the disease progression might reduce the overall relapse rate of these patients from 35.9 % (group A) to 19.4 % (group B3) (P< 0.001). Surveillance procedure is recommended only in patients without vascular invasion in the primary tumor.

[Biologic characteristics of invasive bladder cancer: is there a difference between primary and progressive tumours?]. / Biologická povaha invazívnych nádorov mocového mechúra: existuje rozdiel medzi primárnymi a progresívnymi nádormi?

OBJECTIVE: In most muscle-invasive bladder cancer muscle invasion is present at the time of first diagnosis (primary tumours), in the rest of the patients muscle invasion is caused by progression of superficial tumours (progressive tumours). The aim of study is to determine whether a difference in natural history is between primary and progressive tumours. MATERIAL AND METHODS: In 1997-2001 we treated 278 patients with bladder cancer, 167 (60.1%) patients had superficial tumours and 111 patients had invasive tumours. At the time of diagnosis muscle invasion of the bladder was present in 90 (81.1%) patients, in 21 (18.9%) invasion was formed by progression of superficial tumours. The retrospective study evaluated and compared characteristics of patients (incl. survival) and tumours. Statistical significance was calculated by the chi2 test. RESULTS: A mean age of patients with primary tumours was 65.2 +/- 10.5 years, compared with mean age of 61.7 +/- 12.6 years of patients with progressive tumours. Gender--male:female ratio was 3.1:1 in primary tumours, as opposed to 4.2:1 in progressive. Progression of superficial tumours was noted on average within 35.4 months (range of 7-115). Within one year died 46 out of 90 (51.1%) patients with primary tumours and 11 out of 21 (52.4%) patients with progressive tumours. Three years survived 14 out of 61 (23%) patients with primary tumours and two out of 13 (15.4%) with progressive tumours. CONCLUSIONS: Prognosis of patients with progressive tumours is worse than prognosis of patients with primary invasive tumours. It is vital to detect superficial tumours in their pre-invasive stage, when they can be treated successfully.

Current problems of prostate cancer.

Metastatic prostate cancer is primarily treated by endocrine manipulation. Complete androgen blockade with analogue of luteinizing hormone releasing hormone (LHRH) or surgical castration and antiandrogens seem to have no advantage over the LHRH analogues or surgical castration alone. The progression to a hormone-refractory state is still a challenging issue for urologists because of the lack of standard therapy.

[Corneal topography and LASIK]. / Rohovková topografia a LASIK.

PURPOSE: The purpose of this study is to outline the importance of corneal topography after LASIK surgery and to show the association between topographic findings and postoperative results. PATIENTS: One hundred and fourteen eyes, 70 patients with myopia (from -6.00 to -14.00 Dsph) who underwent surgery by LASIK. METHODS: We identified 5 types of topographic patterns which were classified to symmetric and asymmetric groups. We evaluated the association between the type of topography pattern and the following parameters: age, sex, astigmatism, pre-operative refraction, post-operative uncorrected and best corrected visual acuity. RESULTS: Fifty eight eye filled the criteria of the first group (uniform pattern), 30 eyes of the second group (bowtie), 4 eyes of the third group (penninsula), 3 eyes of the fourth group (semicircular) and 3 eyes of the fifth group (irregular pattern). Significant association between topographic corneal patterns and observed parameters has been confirmed in post-operative uncorrected visual acuity, post-operative refraction and astigmatism (p < 0.05). Age and sex were not significant parameters for the outcome of surgery. CONCLUSION: Majority of eyes (89%) had symmetric corneal topography pattern which highly surpassed our expectations. Comparison of topography patterns with observed parameters proves that the shape of ablation zone influences post-operative quality of vision.

[Effect of drug therapy on lower urinary tract symptoms indicating the presence of benign prostatic hyperplasia in transurethral resection of the prostate]. / Vplyv medikamentóznej liecby príznakov dolných mocových ciest naznacujúcich prítomnost' benígnej prostatickej hyperplázie na transuretrálnu resekciu prostaty.

OBJECTIVE: Medical therapy of lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) has fundamentally changed. The aim of the study is to verify the suggestion that the medical therapy delayed the need of operative treatment and led to changes in characteristics of patients in need of surgery, or whether it had possibly caused deterioration of the results of surgery. MATERIAL AND METHODS: A group of 137 patients treated by TURP in 1991 (before medical therapy was introduced in Slovakia) was compared with a group of 122 patients treated by TURP in 2001 when medical therapy was offered as the primary initial therapy. We evaluated the patient's age, co-morbidity, type and length of medical therapy of LUTS, indications for operation, the weight of the resected tissue, the length of urinary bladder drainage after the operation and the period of hospitalisation. RESULTS: Patients in 2001 were on average 3.1 years older (p = 0.007), co-morbidity was present in 68.6% patients in 1991 compared to 85.2% in 2001 (not significant), and TURP for objective indications was done in 58.4% of patients in 1991 and in 50% in 2001. In 2001 71 out of 122 (58.2%) patients received medical therapy and 30 of them (24.6%) were operated on for objective indications. The weight of the resected tissue was 20.2 +/- 13.2 grams in 1991 and 24.6 +/- 15.4 grams in 2001 (p = 0.027). In 1991 the catheter was removed 4.5 +/- 1.8 days after the operation compared to 3.1 +/- 2.2 days in 2001 (p = 0.0001). The duration hospitalisation in 1991 was 7.7 +/- 5.7 days compared to 5.2 +/- 3.2 in 2001 (p = 0.0001). CONCLUSIONS: Patients receiving medical therapy have surgery at a higher age. The higher age of patients was not related to co-morbidity or the increased number of operations for objective indications, nor did the complications during surgery increase. On average more of the prostatic tissue was removed and the period of hospitalisation was shorter.

[Transurethral resection of the prostate in the treatment of benign prostatic hyperplasia]. / Transuretrálna resekcia prostaty v liecbe benígnej prostatickej hyperplázie.

BACKGROUND AND OBJECTIVES: Transurethral resection of the prostate (TURP) represents a method of choice in surgical treatment of benign prostatic hyperplasia (BPH). The objective of this prospective study was to evaluate TURP mortality and morbidity rates. PATIENTS AND METHODS: In 1998 184 patients with lower urinary tract symptoms (LUTS) indicating the presence of BPH underwent one of the following surgeries: TURP 149 (81%), transurethral incision of the prostate 19 (10.3%), and open surgery (suprapubic transvesical prostatectomy) 16 (8.7%). From the group of 149 patients treated by TURP the following patients were withdrawn from the study: 7 (4.7%) patients with a finding of incidental carcinoma of the prostate and 14 (9.4%) patients who did not attend the postoperative follow-ups. RESULTS: 64 (50%) patients were treated for LUTS syndrome before TURP. TURP was applied in 69 (53.9%) cases for absolute indications. During the surgery and within one year after it, no mortality was recorded. Complications during the surgery were present in 13 (10.2%) patients, and within 24 h after the surgery in 38 (29.7%) patients. Early postoperative complications (up to 4 postoperative weeks) were recorded in 49 (38.3%) patients. Late postoperative complications within 3 month after the surgery occurred in 16 (12.5%) patients, within 6 months in 17 (13.3%) patients, and after 12 months in 17 (13.3%) patients. CONCLUSIONS: Although complications occur almost in 58% of patients, TURP still represents the standard treatment of LUTS indicating the presence of BPH. (Tab. 5, Fig. 2, Ref. 15.).

[Delayed orchiectomy and surgery of metastases after primary chemotherapy in the treatment of advanced testicular tumors]. / Odlozená orchiektómia a metastazektómia po primárnej chemoterapii v liecbe nádoru testis v pokrocilom stádiu.

OBJECTIVE: The therapeutic procedures in the management of testicular germ cell tumors (TGCT) are determined by histological findings in the removed testis and by the extent of the disease at the time of diagnosis. However, all advanced TGCT could be treated by primary chemotherapy (CHT) regardless of histological findings. The current imaging techniques (ultrasonography of the testis, abdominal and thoracic CT examination) and laboratory tests (determination of serum tumor markers AFP and hCG) provide sufficient evidence for the presence of TGCT. In cases of acute abdominal and/or pulmonary symptoms because of life-threatening distant metastases, when the diagnosis of advanced TGCT is evident, it is possible to start the treatment without primary orchiectomy (OE). The aim of this study was to evaluate the advantages of neo-adjuvant CHT with delayed OE in the management of advanced TGCT. MATERIAL AND METHODS: During last 12 years a total of 40 patients with advanced TGCT were treated by neo-adjuvant cisplatin-based combination CHT without previous OE. Eleven patients had bulky mass in the retroperitoneum (Stage IIC), three patients had enlarged retroperitoneal lymph nodes (Stage IIB), two patients had enlarged mediastinal lymph nodes (Stage III). Another 24 patients had pulmonary metastases (Stage IV), 15 of them had also bulky mass in the retroperitoneum and 6 of them in the mediastinum. Following the completion of CHT, OE was performed alone or simultaneously with retroperitoneal lymph node dissection (RPLND) and subsequent lung metastasectomy in cases with persistent residual mass. RESULTS: Complete disappearance of metastases was observed in 13 (32.5%) patients following PVB or BEP CHT alone. The residual mass in the retroperitoneum was removed surgically in 27 patients. In three of them residual tumorous mass was removed also from the lungs without finding of viable tumor. Viable malignant tumor in the removed retroperitoneal tissue was identified in two patients (7.4%). Residual viable malignant tumor in the testis was found in 5 patients (12.5%). Overall survival was 29/40 patients--72.5% (by mean of 55.2 months since the start of the therapy). CONCLUSIONS: The benefit of this therapeutic approach in the immediate management of acute abdominal and/or pulmonary symptoms of life-threatening distant metastases. Another advantage is the like hood of surgical treatment of residual metastatic masses simultaneously with delayed OE on the same day, under one anaesthesia.

Delayed orchiectomy after chemotherapy in patients with advanced testicular cancer.

INTRODUCTION: The therapeutic procedures in the management of testicular cancer are determined by histological findings in the removed testis and by the extent of the disease at the time of diagnosis. However, all advanced tumors could be treated by primary chemotherapy regardless of the histological findings. The current imaging techniques (ultrasound of the testis, abdominal and chest CT examination) and laboratory tests (determination of serum tumor markers AFP and hCG) provide sufficient evidence for the presence of cancer. When the diagnosis of advanced tumor is evident, it is possible to start the treatment without orchiectomy. The aim of this study was to evaluate the advantages of neo-adjuvant chemotherapy with delayed orchiectomy in the management of advanced testicular cancer. MATERIAL AND METHODS: A total of 36 patients with advanced germ cell testicular cancer underwent primary PVB or BEP chemotherapy without previous orchiectomy. Mean age of patients was 32 years. Detailed medical, surgical and urological examination showed pulmonary metastases and/or extensive abdominal tumorous masses imitating acute abdominal crisis and impaired drainage of the kidney due to ureteral obstruction. Searching for the origin, testicular tumor was detected. Eleven patients had a bulky disease in the retroperitoneum (Stage IIC), two had enlarged retroperitoneal lymph nodes (Stage IIB), two had enlarged mediastinal lymph nodes (Stage III) and other 16 patients had also pulmonary metastases, and 5 pts had pulmonary metastases only. The patients were treated with cisplatin-containing combination chemotherapy. Following completion of chemotherapy, orchiectomy was performed alone or simultaneously with retroperitoneal lymph node dissection (RPLND) and/or lung metastasectomy in cases with persistent residual mass. Following orchiectomy the patients were regularly checked and in cases with viable malignant tumor found in the testis sequential chemotherapy was administered. Similarly when the relapse of the disease was detected, the patients were treated with sequential chemotherapy. RESULTS: Complete disappearance of metastases was observed in 12 patients following chemotherapy alone. The residual mass persisted in 24 patients (in 22 out of them in the retroperitoneum and in two patients also in the lungs) and was removed surgically. The viable tumor in the removed tissue was found in one patient. Delayed orchiectomy was performed simultaneously with surgical removal of residual mass in the retroperitoneum in 24 patients and as a separate procedure in 12 patients who have been considered to be complete responders following chemotherapy alone. Residual viable tumor in testicular specimen was found in three patients, necrotic or fibrotic tissue in 18, and mature teratoma in 15 patients. Overall survival of the patients was 26/36 (72.7%) at mean of 56.9 months (range 7-145 months, median 50 months) since the start of the treatment. CONCLUSIONS: In patients with advanced germ cell testicular cancer preference must be given to the early beginning of intensive chemotherapy without the need of tissue diagnosis of primary tumor that should be obtained by orchiectomy. Benefit of this therapeutic approach is the timely management of acute abdominal and/or pulmonary symptoms of life-threatening distant metastases.

Bilateral testicular germ-cell tumors--a single centre long-term experience.

OBJECTIVES: The incidence of bilateral testicular tumors (BTT) had increased over the preceding decade. The aim of the present study is to analyse a group of patients with BTT and to high-light the need for long-term follow-up of patients treated in a single centre. MATERIAL AND METHODS: 27 (2.8%) out of 960 patients with germ-cell testicular tumors (GCTT), treated between 4/1977 and 8/2001, developed bilateral disease. All of them underwent radical orchiectomy (in one patient was done delayed orchiectomy after primary chemotherapy due to advanced disease). Additional treatment was planned according to the histologic type and clinical stage of the disease, and previous treatment as well. The survival data were reviewed. RESULTS: 24 out of 27 patients (88.9%) developed the 2nd tumor metachronously (median interval 66 months, range, 4-197 months) and three (11.1%) had synchronous BTT. Only 7 patients (25.9%) had identical histological types on both sides (6 of them with pure seminomas, one with embryonal carcinoma). Two of three synchronously developed BTT had different histologic types on both sides. GCTT of one histologic type were observed in respect of the first tumor: 11 seminomas, three embryonal carcinomas, in respect of the 2nd tumor: 10 seminomas, three embryonal carcinomas, in respect of the 2nd tumor: 10 seminomas, three embryonal carcinomas and one mature teratoma. GCTT of more than one histologic type were observed in respect of the first and the 2nd tumors: 6 mixed GCTT with seminoma component and 7 without seminoma component. Majority of BTT was presented in clinical stage I (in respect of the first tumor in 70.4%, in respect of the 2nd tumor in 62.9%). The median duration of the follow-up after the diagnosis of the first GCTT was 149 months (range, 13-288 months) and after the diagnosis of the contralateral GCTT was 68 months (range, 1-167 months). Twenty-five patients (92.6%) were alive with NED at their last follow-up visit. Two patients died by mean of 22.5 months (range, 21-24 months) after the 2nd orchiectomy. CONCLUSIONS: All patients with unilateral GCTT have an increased risk of developing a contralateral testicular tumor, even decades after diagnosis. Management should be individualised for each patient.

Prognostic factors in clinical stage I nonseminomatous germ cell testicular tumors: rationale for different risk-adapted treatment.

OBJECTIVE: Surveillance after orchiectomy alone becomes popular for the management of clinical stage I nonseminomatous germ cell testicular tumours (CS I NSGCTT). Effort to identify patients at high risk of relapse leads to searching prognostic factors of CS I NSGCTT. The aim of this study was to identify those patients in whom a surveillance policy is less likely to be successful. PATIENTS AND RESULTS: Seventy-two CS I NSGCTT patients were stratified to different risk-adapted therapeutic approaches according to histopathologic findings of primary tumor removed by inguinal orchiectomy. Eighteen patients (group A) with vascular invasion and majority of embryonal carcinoma component in the primary tumor were treated with adjuvant BEP chemotherapy. None of them experienced disease progression after a median follow-up period of 36 months after orchiectomy. Five patients (group B) with vascular invasion and the majority of teratomatous elements in the primary tumor have been followed up 56 months after orchiectomy. They were treated with primary retroperitoneal lymph node dissection (RPLND). Two of them (40%) had pathologic stage II after RPLND and underwent subsequent chemotherapy. One of them died due to disease progression 29 months following orchiectomy. Another one lives with no evidence of disease (NED). Three patients in pathologic stage I are alive with NED. Forth-nine patients (group C) without vascular invasion have been followed up for a median duration of 37 months after orchiectomy. They were kept under close surveillance, consisted of regular follow-up with tumor markers, chest x-ray and CT of the retroperitoneum. Disease progression was observed in 7 (14.3%) patients after a median duration of 8 months after orchiectomy. They were treated with BEP chemotherapy and live with disease-free median survival of 22 months after completion of therapy. The overall survival rate of all 72 patients was 98.6%. The median survival for all patients was 37 months (range 7-73). CONCLUSIONS: The authors will continue to use surveillance policy only in patients without vascular invasion in the primary tumor.

[Incidental renal carcinoma]. / Incidentálny karcinóm oblicky.

BACKGROUND: The increasing use of progressive noninvasive diagnostic imaging techniques, has substantially increased the detection of incidentally detected renal cell carcinoma (RCC). OBJECTIVES: To determine the manner of presentation of RCC and the frequency of incidentally detected RCC. The natural history of RCC of incidentally discovered RCC was compared with that of symptomatic RCC, the reasons for examination and the methods of diagnosis in patients with incidental tumours were analysed. PATIENTS AND METHODS: In a retrospective study, 463 patients with RCC treated between 1981 and 1995 were reviewed. The patients were divided into four groups according to the fact as to whether the tumours were diagnosed on the basis of urologic symptoms, with paraneoplastic syndromes, with symptoms of metastatic disease, or whether they were detected incidentally. The records of 180 patients with RCC treated between 1991 and 1995 were grouped according to the fact as to whether the tumour was detected incidentally (n = 85), or whether it was discovered with symptoms related to the neoplastic renal disease (n = 95). The groups were compared regarding patient's age, sex, tumour size, grade of malignancy, stage and survival using univariate analyses. RESULTS: The number of RCC detected incidentally has increased from 9.3% (1981-1985) to 47.2% (1991-1995). There were significant differences between groups in the distribution of clinical stages, T1 + T2 stages were more frequently detected in incidental tumours (p < or = 0.005). No significant difference was observed between the survival of incidental and symptomatic patients. Abdominal ultrasonography was the most useful method for the detection of incidental RCC (88.2%). CONCLUSIONS: The results of this study suggest that the incidentally detected RCC occur in lower stages than the symptomatic tumours.

[Will determination of prostate specific antigen density improve the diagnosis of prostatic carcinoma?]. / Pomôze sledovanie hustoty prostatického specifického antigénu zlepsit' diagnostiku karcinómu prostaty?

Prostate specific antigen (PSA) serum levels in patients with prostate carcinoma and with benign prostate hyperplasia overlap. In order to improve the positive predictive value of PSA in the diagnosis of prostate carcinoma the authors recommend to evaluate the PSA levels in relation to the prostate volume, the so-called density of the prostate specific antigen (PSAD). The correlation of PSA and PSAD with results of bioptic examination revealed that PSAD does not increase the capacity of PSA to predict the presence of prostate carcinoma and does not reduce the number of prostate biopsies. All patients with PSA levels higher than 4 ng/ml and/or a pathological finding on digital rectal examination need a bioptic examination of the prostate.

[The antiandrogen withdrawal syndrome: decrease in prostate specific antigen serum levels after withdrawal of antiandrogens]. / Syndróm vysadenia antiandrogénov: pokles sérových hladín prostatického specifického antigénu po vysazení antiandrogénov.

Combined androgen blockade using surgical or medical (luteinizing hormone-releasing hormone agonist) castration in association with anti-androgen has become the primary therapy in patients with metastatic prostate cancer. Patients undergoing combined androgen blockade will progress within 18-30 months after initial hormonal therapy. When progression occurs following combined androgen blockade, the non-steroid anti-androgen should be subsequently withdrawn. Several recent reports have been published on the paradoxical effect of anti-androgen withdrawal. Eight (22.9%) of 35 patients showed a decline in PSA levels following flutamide withdrawal. The mean time to progression following combined androgen blockade was 26 month and the mean duration of response to flutamide withdrawal was 4.1 months.

Management of germ cell testicular cancer with pulmonary metastases.

Twenty eight patients with germ cell testicular cancer pulmonary metastases received primary chemotherapy including bleomycin, etoposide, and cisplatin (BEP). Complete response was achieved in 21 (75%) patients, in 11 of them CR was achieved following chemotherapy alone. Postchemotherapy surgery of residual mass was performed in 12 (42.9%) patients with normalized serum tumor markers. Retroperitoneal lymph node dissection was performed in one patient, pulmonary surgery in four, and both postchemotherapy treatments in 7 patients. Overall cure rate was 89.3%, 26 (92.9%) patients are still alive at a mean follow-up of 19.7+ months (range, 3-34+ months) after the treatment start. Two (7.1%) patients died: one of them due to disease progression during chemotherapy, and the second one due to postoperative complication (acute respiratory failure). Relapse of disease was observed in one patient 21 months following CR achievement, and sequential chemotherapy was introduced. Authors recommend surgical remove of all radiologically detected residual deposits, because the available imaging methods are not adequate for determining the histologic composition of residual mass, which is decisive for further therapy and has prognostic value.